房水中细胞因子与玻璃体腔注射康柏西普治疗视网膜中央静脉阻塞继发黄斑水肿预后的相关性分析

Correlation analysis of cytokines in aqueous humor and intravitreal injection of conbercept for macular edema secondary to central retinal vein occlusion

目的探究房水细胞因子与视网膜中央静脉阻塞继发黄斑水肿(CRVO-ME)抗血管内皮生长因子(VEGF)治疗疗效的相关性分析。方法选取2019年7月至2021年12月于我院行康柏西普玻璃体腔注射的50例(50只眼)CRVO-ME患者进行前瞻性分析,根据治疗6个月后黄斑中央厚度(CMT)降幅是否≥100μm,分为显著组(≥100μm,38例)和不显著组(<100μm,12例),比较两组患者的一般资料和房水细胞因子水平,分析房水细胞因子与CRVO-ME抗VEGF治疗疗效的相关性。结果两组患者在接受抗VEGF药物注射后6个月,CMT,最佳矫正视力(BCVA)均得到改善,但不显著组明显低于显著组,差异有统计学意义(P=0.036,0.023)。治疗前不显著组的白细胞介素(IL)-6、IL-8高于显著组,差异有统计学意义(P=0.046,0.021),VEGF水平在两组间无显著差异。通过Pearson进行相关分析,房水中IL-6、IL-8水平与CMT降幅呈显著负相关(r=-0.819,P=0.008;r=-0.923,P=0.012),VEGF水平与CMT降幅呈显著正相关(r=0.731,0.012)。经过多因素Logistic回归分析显示,房水中IL-6,IL-8的表达水平是影响玻璃体腔注射康柏西普治疗效果的独立危险因素(OR=0.482,95%CI 0.314~0.698;OR=0.321,95%CI 0.379~0.529),与此同时VEGF是影响玻璃体腔注射康柏西普治疗疗效的独立保护因素(OR=1.039,95%CI 1.009~1.078)。结论房水IL-6、IL-8和VEGF水平与CRVO-ME患者抗VEGF治疗疗效存在相关性,玻璃体腔内注射抗VEGF药物联合抗炎药物,可能是CRVO-ME更佳的治疗方法。

Objective To explore the correlation between aqueous humor cytokines and the efficacy of anti-vascular endothelial growth factor(VEGF)therapy in central retinal vein occlusion secondary macular edema(CRVO-ME).Methods This retrospective case series enrolled fifty patients with CRVO-ME who received intravitreal injection of Conbercept in our hospital from July 2019 to December 2021,and divided into significant group(≥100μm,38 cases)and insignificant group(<100μm,12 cases).The general data and the cytokine levels of the aqueous humor were compared between the two groups,and the relationship between the cytokines in the aqueous humor and the efficacy of anti-VEGF therapy for CRVO-ME was analyzed.Results The central macular thickness(CMT)and best corrected visual acuity(BCVA)of the two groups were improved at 6 months after receiving anti-VEGF drug injection,but the insignificant group was significantly lower than the significant group(P=0.036,0.023).Before the treatment,the levels of interleukin(IL)-6 and interleukin(IL)-8 in the insignificant group were higher than those in the significant group(P=0.046,0.021).There was no significant difference in VEGF level between the two groups.Through the Pearson correlation analysis,the levels of IL-6 and IL-8 in the aqueous humor were significantly negatively correlated with the decrease in CMT(r=0.819,P=0.008;r=-0.923,P=0.012),VEGF level was significantly positively correlated with the decrease of CMT(r=0.731,0.012).Multivariate Logistic regression analysis showed that the expression levels of IL-6 and IL-8 in aqueous humor were independent risk factors for the effect of intravitreal injection of conbercept odd ratio(OR=0.482,95%confidence interval CI 0.314-0.698;OR=0.321,95%CI 0.379~0.529),and VEGF was an independent protective factor affecting the efficacy of intravitreal injection of conbercept(OR=1.039,95%CI 1.009~1.078).Conclusions The levels of IL-6,IL-8 and VEGF in aqueous humor are correlated with the efficacy of anti-VEGF therapy in patients with CRVO-ME.Intravitreal injection of anti-VEGF drugs combined with anti-inflammatory drugs may be a better treatment for CRVO-ME.